{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T12:36:29Z","timestamp":1790080589325,"version":"4.0.1"},"reference-count":25,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2020,6,26]],"date-time":"2020-06-26T00:00:00Z","timestamp":1593129600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Endovasc Ther"],"published-print":{"date-parts":[[2020,10]]},"abstract":"<jats:p>Purpose: To investigate whether patients who develop aneurysm sac shrinkage following endovascular aneurysm repair (EVAR) have better outcomes than patients with a stable or increased aneurysm sac. Materials and Methods: The Healthcare Databases Advanced Search interface developed by the National Institute for Health and Care Excellence was used to interrogate MEDLINE and EMBASE. Thesaurus headings were adapted accordingly. Case-control studies were identified comparing outcomes in patients demonstrating aneurysm sac shrinkage after EVAR with those of patients with a stable or expanded aneurysm sac. Pooled estimates of dichotomous outcome data were calculated using the odds ratio (OR) and 95% confidence interval (CI). Meta-analysis of time-to-event data was conducted using the inverse-variance method; the results are reported as a summary hazard ratio (HR) and 95% CI. Summary outcome estimates were calculated using random-effects models. Results: Eight studies were included in quantitative synthesis reporting a total of 17,096 patients (8518 patients with sac shrinkage and 8578 patients without sac shrinkage). The pooled incidence of sac shrinkage at 12 months was 48% (95% CI 40% to 56%). Patients with aneurysm sac shrinkage had a significantly lower hazard of death (HR 0.73, 95% CI 0.60 to 0.87), secondary interventions (HR 0.42, 95% CI 0.29 to 0.62), and late complications (HR 0.37, 95% CI 0.24 to 0.56) than patients with a stable or increased aneurysm sac. Furthermore, their odds of rupture were significantly lower than those in patients without shrinkage (OR 0.09, 95% CI 0.02 to 0.36). Conclusion: Sac regression is correlated to improved survival and a reduced rate of secondary interventions and EVAR-related complications. The prognostic significance of sac regression should be considered in surveillance strategies. Intensified surveillance should be applied in patients who fail to achieve sac regression following EVAR.<\/jats:p>","DOI":"10.1177\/1526602820937432","type":"journal-article","created":{"date-parts":[[2020,6,26]],"date-time":"2020-06-26T17:50:07Z","timestamp":1593193807000},"page":"857-868","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":64,"title":["Prognostic Significance of Aneurysm Sac Shrinkage After Endovascular Aneurysm Repair"],"prefix":"10.1177","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8209-0406","authenticated-orcid":false,"given":"George A.","family":"Antoniou","sequence":"first","affiliation":[{"name":"Department of Vascular & Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Northern Care Alliance NHS Group, Manchester, UK"},{"name":"Division of Cardiovascular Sciences, School of Medical Sciences, The University of Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aws","family":"Alfahad","sequence":"additional","affiliation":[{"name":"Department of Radiology, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Northern Care Alliance NHS Group, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stavros A.","family":"Antoniou","sequence":"additional","affiliation":[{"name":"Department of Surgery, Mediterranean Hospital of Cyprus, Limassol, Cyprus"},{"name":"School of Medicine, European University Cyprus, Nicosia, Cyprus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Torella","sequence":"additional","affiliation":[{"name":"Liverpool Vascular & Endovascular Service, Liverpool, UK"},{"name":"School of Physical Sciences, University of Liverpool, UK"},{"name":"Liverpool Cardiovascular Service, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2020,6,26]]},"reference":[{"key":"bibr1-1526602820937432","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)31135-7"},{"key":"bibr2-1526602820937432","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1715955"},{"key":"bibr3-1526602820937432","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2017.05.122"},{"key":"bibr4-1526602820937432","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2019.11.030"},{"key":"bibr5-1526602820937432","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2018.09.020"},{"key":"bibr6-1526602820937432","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.b2700"},{"key":"bibr7-1526602820937432","doi-asserted-by":"publisher","DOI":"10.1016\/S0741-5214(97)70363-X"},{"key":"bibr8-1526602820937432","unstructured":"Wells GA, Shea B, O\u2019Connell D, et al. 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